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Strength and Motion

Hand strength & motion assessment: grip/pinch strength correlation to function, normative data, and impact of common pathologies.

138 citationsUpdated Oct 2026

Overview

Physical outcome measures are shifting toward patient-reported outcomes, as range of motion and strength are considered less reliable than previously thought [1]. Functional range of motion remains critical for directing surgical indications, guiding rehabilitation, and assessing treatment outcomes [2]. However, distal interphalangeal joint range of motion and hand grip strength in individual patients have little value for predicting isolated finger flexion force [3]. Age will most likely have a significant effect on postoperative range of motion and strength [14]. Digits require sensation and freedom of motion to enable effective use, and effective surgery restores biomechanical motions so patients have optimum use [24].

Assessment tools and protocols vary significantly. New features of digital dynamometers, unavailable with the analog Jamar dynamometer and unaccounted for in existing clinical guidelines, could potentially influence grip scores [9]. A method of controlled torque and joint position has been used experimentally and clinically as a tool for objective assessment of passive range of motion [11]. Standardized procedures are needed when testing torque strength [146]. Surface electromyographic signal studies aim to identify the specific amount of motion allowed within immobilization devices and the level of function allowed within each device to establish data for evidence-based decisions [33]. Functional capacity evaluations should not replace the surgeon's determination of a patient's abilities based on objective physical examination and radiographic findings [22]. The best form of assessing the ability to return to work is based on a competent physician's understanding of residual impairments combined with knowledge of the patient's work requirements [22].

Specific clinical contexts demonstrate variable impacts on strength and motion. Patients with posttraumatic arthritis following distal radius fractures experienced diminished range of motion and poorer patient-reported outcomes regarding general functioning and satisfaction, but no altered grip strength [5]. Cross-education effects on shoulder rotator muscle strength and function after shoulder stabilization surgery have no effect on functional outcomes [6]. Isolated gracilis tendon harvesting is not associated with loss of strength and maintains good functional outcome [7]. Early active motion rehabilitation may not lead to better range of motion long-term than passive motion protocols following flexor tendon repair [13]. The Latarjet procedure more commonly affects range of motion rather than shoulder and elbow strength [15]. Patients using low-profile outriggers require more strength to initiate and maintain active movement opposite to the mobilizing force, even when dynamic-assist forces are equal [16]. Exercise regimens for carpometacarpal osteoarthritis are developed to preserve CMC joint range of motion and increase the strength of the stabilizing muscles of the thumb [31]. Successful replantation for a radiocarpal joint amputation is associated with major restriction of motion, decreased strength, and moderate disability on functional outcome assessments [34]. First ray stabilization with mini-tightrope is a valuable solution to maintain good mobility in patients with low strength requirements on their daily lives [59]. Achieving a functional and durable outcome in total wrist arthroplasty requires proper patient selection, careful preoperative planning, and accurate implantation [61]. Bilateral handgrip strength assessments have potential clinical utility in guiding rehabilitation strategies after rotator cuff repair [62]. Patients undergoing distal radioulnar joint constrained arthroplasty were able to return to regular activities with excellent range of motion and restored lifting capacity, reporting no pain and utmost satisfaction with the prosthesis [142].

Anatomy & Pathophysiology

Osseous Architecture and Kinematics

The skeleton of the hand and wrist comprises 27 bones, 19 of which are long bones [38]. The hand skeleton is organized into five rays, each forming a polyarticulated chain of metacarpals and phalanges [38]. The wrist possesses three axes of movement, including pronation and supination from the forearm, permitting the hand to be positioned in any spatial configuration for grasping [38]. In the sagittal plane, the thumb metacarpal makes an angle of approximately 45 degrees with the second metacarpal, allowing the thumb to oppose the other four digital rays [38]. The transverse axis of the palm is oblique, forming an acute angle of approximately 75 degrees with the longitudinal axis [38].

The index metacarpal is the most firmly fixed element of the metacarpal arch [73]. The fifth metacarpal has a range of flexion–extension of approximately 20 degrees at its carpal articulation [73]. The metacarpophalangeal joints serve as the keystones of the longitudinal arches of the hand, stabilized by thick anterior glenoid capsules known as volar plates [73]. The axes of flexion for the metacarpophalangeal and proximal interphalangeal joints are arranged such that flexion causes the fingers to converge toward the scaphoid [81].

Musculotendinous Anatomy

Extrinsic muscles originate outside the hand and insert on the hand or carpus, while intrinsic muscles have both origin and insertion within the hand [37]. The extrinsic extensors run through six different fibroosseous retinacular compartments at the wrist level [37]. The extensor digitorum communis tendons of the middle, ring, and little fingers are tethered together by juncturae tendinum over the dorsum of the hand proximal to the metacarpophalangeal joint [37]. Sagittal band fibers form a sling that transmits proximal extrinsic extensor tension to the proximal phalanx, permitting metacarpophalangeal joint extension without a direct tendinous insertion onto the proximal phalanx [37]. Rupture or attenuation of sagittal band fibers allows the extrinsic extensor tendon to sublux to the ulnar side of the metacarpal head, causing ulnar deviation of the finger [37].

The flexor digitorum profundus inserts on the proximal volar aspect of the distal phalanx, flexing the distal interphalangeal, proximal interphalangeal, and metacarpophalangeal joints [37]. The flexor digitorum superficialis tendon bifurcates around the flexor digitorum profundus at the beginning of the A2 pulley and inserts via radial and ulnar slips into the proximal metaphysis of the middle phalanx [77]. The A2 and A4 annular pulleys are the most essential structures in maintaining the mechanical advantage of the flexor tendons [77].

There are seven interosseous muscles in the hand, consisting of four dorsal and three volar muscles [70]. The dorsal interossei are abductors, while the volar interossei are adductors [70]. The middle finger has two dorsal interossei and no volar interossei because the central axis of the hand lies within it [70]. The deep head of each dorsal interosseous muscle forms a lateral band that flexes and weakly abducts the proximal phalanx while extending the middle and distal phalanges [70]. Simultaneous activation of the flexor digitorum profundus and intrinsic muscles results in altered kinematics and larger fingertip-to-palm distances compared with flexor digitorum profundus activation alone [117].

Soft Tissue and Gliding Mechanisms

The dorsal skin of the hand is thin, possesses a normal pilosebaceous system, and has loose connections with deeper planes that allow free gliding [79]. Flexion of the fingers produces a significant lengthening of the dorsal skin, with an average increase of 3 cm in the middle finger from extension to full flexion [79]. The palmar skin is subdivided into functional units, with the central triangular part of the palm being fixed and poorly vascularized, covering the superficial palmar aponeurosis [69].

The gliding mechanism of tendons in narrow crowded areas is assured by synovial sheaths surrounded by fibrous sheaths that act as pulleys when the tendon changes direction [78]. The tenosynovium lining the fibroosseous tunnel supplies nutrition and lubrication to the poorly vascularized flexor tendons [77]. Within the flexor tendon sheath, tendon vascularity is supplied via the vincula system, specifically the vinculum longus and brevis [77].

Biomechanics and Pathomechanics

Painless and full hand function requires seamless integration of joints, muscles, and nerves [18]. Ideally, digits need sensation and freedom of motion to enable effective use, and effective surgery restores biomechanical motions for optimum patient use [24]. Intra-articular gaps from distal radius fractures result in significant joint incongruity that can interfere with wrist and hand function [42]. Radial shortening following distal radius fracture results in loss of volar tilt, interferes with the function of the distal radioulnar joint, and can lead to midcarpal instability [42]. Extra-articular malalignment of the distal radius is associated with pain and decreased grip strength [42].

Progressive metacarpal shortening produces proportionally greater loss of fingertip flexion force at increasing amounts of finger flexion [106]. The intrinsic plus deformity is caused by excessive intrinsic muscle tension, preventing full proximal interphalangeal joint flexion when the metacarpophalangeal joint is fully extended [91]. Flexor tenosynovitis may produce limitation of interphalangeal joint motion, resulting in a range of active flexion significantly less than passive flexion [91]. Limited joint mobility of the thumb and index finger may cause temporal changes in precision grip force control, leading to reduced manual dexterity [88].

The dynamic interaction of finger joints during cylinder grip shows specific patterns, with distal interphalangeal joints consistently initiating flexion last [98]. Synchronization of finger joint flexion during cylinder grip increases significantly by the end of motion compared to the beginning [98]. The middle finger is the most important contributor to grip strength [101]. At a position of 30 degrees of wrist extension, maximal grip strength is achieved without significantly compromising grip endurance [111]. Dynamic grip strength differs from static grip strength measured with the wrist in a standardized static position [107].

Grip-load force adjustments are not completely determined by the mechanics of object motion, as nonmechanical factors such as perceptual factors may affect the coupling [97]. Individuals with hand osteoarthritis apply higher grip forces at liftoff and peak and demonstrate longer latency compared to controls [95]. The effect of blocking flexion of one finger on the other digits varies considerably between individuals, preventing prediction of the effect of stiffness on hand strength [39]. Range of motion in the distal interphalangeal joint and hand grip strength are of little value for predicting isolated finger flexion force in an individual patient [3].

Classification

Kellgren–Lawgrade: In studies of hand osteoarthritis, radiographs are graded 0–4 using the ordinal criteria of Kellgren and Lawrence [10]. Participants with radiographs interpreted as Grade 0 or 1 are considered free of OA, while those with Grade 2, 3, or 4 are classified as having OA [10].

Bayne–Klug: This radiological classification describes the type and extent of bone defect associated with radial deficiency, specifically indicating whether support for the hand is present [155]. In Bayne–Klug types III and IV, support for the hand is completely lacking [155].

OTA: Fractures are classified using the OTA system, which includes extra-articular and intra-articular categories [192]. In one study cohort, there were 17 extra-articular fractures and 23 intra-articular fractures [192]. Specific subtypes included 15 A3.2, 11 C2.1, eight C3.2, two each of A3.3 and C2.2, and one each of C3.3 and C2.3 fractures [192]. Only one of the intra-articular fractures had intra-articular displacement [192].

Gustilo: Open fractures are classified by the Gustilo system; in the referenced study, one fracture was Gustilo grade 1 open [192].

Other Considerations: Physical outcome measures are transitioning toward patient-reported outcomes, as range of motion and strength are not as reliable as previously thought [1]. Functional range of motion is critical for directing surgical and rehabilitation indications and for assessing treatment outcomes [2]. In the distal interphalangeal joint, range of motion and hand grip strength in the individual patient are of little value for predicting isolated finger flexion force [3]. The AMC Disc-O-Gram classification system measures efficacy as movement and function improve [20]. The term "Stiffness" requires an exact description of the load configuration and the exact localization and kind of deformation measured [141].

Assessment Reliability: Manual muscle testing (MMT) is the standard for evaluating intrinsic hand muscles, graded on the Medical Research Council (MRC) or Oxford Scale from 0 to 5 [29]. Grade 0 indicates complete paralysis, grade 3 indicates movement against gravity (or full active range of motion in modified hand assessments), and grade 5 indicates normal strength [29]. MMT was first developed by Lowman in 1911, with gravity-based grades introduced by Lovett [29]. In the hand, a group of muscles is usually tested rather than a single muscle, and some authors suggest labeling the movement rather than the muscle [29]. Not all hand muscles can be sufficiently isolated to grade their strength, and it is not always necessary to test all muscles innervated by a particular nerve to evaluate motor function impairment [53]. Hand-held devices are not justified for grading strength except in a few instances, and there is no substitute for manual testing for muscle length [25]. Unless handheld dynamometry is widely adopted or a better validated grading system is developed, the MRC will continue to be used [129].

Instrumented Measurement: A novel finger grip dynamometer system measures each finger's grip strength simultaneously and records the time course of grip motion, allowing objective quantification of symptoms [4]. The Multiple Angle Testing Method assesses muscle group strength following disease or surgery, determines therapy effectiveness, and detects old muscle injuries missed by existing diagnostic methods [8]. A microcomputer-based system for measuring hand strength is accurate, reliable, and easy to operate [47]. The motion analysis system is a reliable tool for evaluating fingertip motion, and the closed curve derived from it is easier to interpret and comparable in serial examinations [17, 149]. The measured angular motion of each individual joint should be recorded for accurate comparison [35]. Evidence-based administration and interpretation of grip strength assessment by rehabilitation professionals are essential across the continuum of care [140].

Joint Kinematics: Isolated flexion of the metacarpophalangeal (MCP) joint is not possible to the full extent in any finger; associated flexion at the proximal interphalangeal (PIP) joint occurs when isolated MCP flexion is attempted [185]. Full MCP-joint flexion with 45 degrees or less of PIP-joint flexion was achieved in only five fingers; in all other fingers, associated PIP flexion exceeded 45 degrees at the end of the test movement [185]. Two patterns of MCP-joint flexion were identified: a nearly normal pattern (15% of fingers) where MCP flexion occurred with little associated PIP flexion until late stages, and a more common pattern (85% of fingers) where MCP flexion was associated with PIP flexion even during early stages [185]. Non-dimensional analysis supported this visual classification, with the nearly normal pattern considered an extreme variation rather than qualitatively different [185]. In the fingers, only a small percentage of the active range of motion of the joints was required for functional tasks [152]. Improved understanding of carpal motion patterns may lead to changes in functional rehabilitation and surgical management [26]. From all analyzed motions, the highest Fossa-Foveolar Mismatch was found in external rotation in all groups [135]. More study of anatomical morphological patterns may explain variations in motion and grip-strength [36].

Clinical Outcomes: Accurate diagnosis and management of hand and carpal fractures and dislocations are predicated on a thorough physical examination and appropriate imaging to limit joint stiffness while preserving mobility and function [19]. For Colles' fractures, functional results were significantly better in the brace-treated group at 8, 13, and 26 weeks [170]. Grip strength was better in the brace group at splint removal and at 8 weeks, but this advantage was lost by 13 weeks [170]. Pinch strength in the brace group remained significantly better than the control group throughout most of the treatment and follow-up period [170]. No differences were observed among low back pain subgroups regarding physical abilities [65]. Strength of the thumb is affected in all types of triphalangeal thumb, though thumb strength is apparently sufficient for daily life in the investigated group [139].

Rehabilitation and Training: The exercise regimen for carpometacarpal osteoarthritis was developed in accordance with American College of Sports Medicine guidelines to preserve CMC joint range of motion and increase the strength of the stabilizing muscles of the thumb [31]. Resistance training, a general term for strength, power, and plyometrics training, has been shown to produce strength gains in children and adolescents with cerebral palsy [193]. Muscle plasticity, including hypertrophy and neural adaptations, has been demonstrated in youth with cerebral palsy in response to resistance training [193]. The degree of strength gains is variable due to heterogeneity in participants (severity levels, ages), exercise types, targeted muscle groups, and dosing parameters [193]. Dosing refers to the delivery of a therapeutic agent in a specified manner, with parameters including frequency (sessions per week), volume (sets and repetitions), intensity (load or weight, typically a percentage of one-repetition maximum), duration, and velocity [193]. Although specific guidelines for children with cerebral palsy have not been developed, the National Strength and Conditioning Association (NSCA) guidelines for typically developing children are used as a reference for dosing parameters, as they are based on sound evidence and physiological principles that are safe and effective [193].

Reliability Statistics: The Kappa statistic for agreement between raters on end-feel classifications (springy vs non-springy) was 0.42, with a percent agreement of 68.4% [169]. The inter-rater reliability ICC for the Torque Angle Curve technique was .80 [169].

Clinical Presentation

General Principles and Examination Strategy

A careful physical examination is essential to direct care and future testing, as diagnostic tests such as imaging and serum laboratory studies can be expensive, time-consuming, and often nonspecific [18]. Patients often have difficulty accurately describing their symptoms and may incorrectly attribute pathology to a perceived deficit, whether real or imagined [18]. Physical outcome measures are being changed for the use of patient reported outcomes, and range of motion and strength are not as reliable measures as one would think [1]. The functional range of motion is important for directing indications for surgery and rehabilitation, and assessing outcome of treatment [2]. Assessments using range-of-motion measurements or a questionnaire are not sufficient to evaluate a patient's movement disorder, and a kinematic analysis should be conducted for quantitative assessments [125]. Those subjects with stenosing tenosynovitis demonstrate a significant decrease in maximum velocity in slow fist tasks, highlighting the need for comprehensive assessment to ascertain the full extent of functional limitations [108].

Strength Assessment

Decreased grip strength in a patient with “obscure” wrist pain is a reliable indicator of a pathologic process that deserves further investigation [21]. There is no substitute for manual testing for muscle length, and hand-held devices are not justified for grading strength except in a few instances [25]. Standard manual strength-testing of the intrinsic muscles of the hand was not diagnostically sensitive [94]. Not all muscles in the hand can be sufficiently isolated to grade their strength, nor is it always necessary to test all muscles innervated by a particular nerve to evaluate the presence or extent of motor function impairment or monitor changes [53]. Repeat testing appears essential for an accurate assessment of an individual's strength [49]. Rapid, repeated measurement of grip strength is not a reliable discriminator of true and faked hand weakness [30]. For the results of individual patients, the calculated Standard Error of Measurements and the Smallest Detectable Differences indicate that only relatively large changes in strength can be confidently detected with a hand-held dynamometer technique [48]. The majority of hands (256, or 89%) had a maximal grip strength at setting II [27]. The test-retest reliability of grip strength measurement in full elbow extension in healthy participants is excellent, demonstrating its potential for use in clinical practice [118]. Providers can use the strongest grip strength values obtained in clinical practice to compare with reported dominant hand grip strength values [105]. For use as a diagnostic tool, standardization and device-specific cutoff points for handgrip dynamometry are needed [110]. These findings suggest the need to consider how new features, unavailable with the analog Jamar dynamometer and unaccounted for in existing clinical guidelines, could potentially influence grip scores [9]. Numerous clinical and epidemiological studies have shown the predictive potential of hand grip strength regarding short and long-term mortality and morbidity [28]. Multifinger performance was not predictable from single-finger strengths, and the information derived may be helpful to clinically identify and isolate muscle pathology [115]. The measurement of extension grip strength is a useful objective tool to aid in the diagnosis of lateral epicondylitis [41]. Most patients with CTS do not appear to have notable weakness of thumb abduction strength [40]. Measurement of thumb abduction strength may prove to be a useful adjunct to the various tests currently used by hand surgeons to assess hand function [50]. The study validates a repeatable technique for measuring palmar thumb abduction strength with excellent nonparametric reliability, though large differences between raters and a lack of variability in the sample limit clinical utility and require further study with a larger, more diverse population [51]. Although deQuervain's disease affects abductor and extensor tendons, strength and ROM of the thumbs were found to be decreased in all directions tested [123]. Affected hands demonstrated diminished results with FDT, and pinch strength when compared with previously published ranges for normals [126]. This new system that measures each finger's grip strength at one time and records the time course of grip motion could quantify a patient's symptoms easily and objectively, which may contribute to the evaluation of hand function [4]. Our findings support that we have presented a tool which can be used in future study within this population to better understand the hand kinetics associated with the highly problematic task of jar-opening and joint protection strategies intended to reduce hand loads [43].

Range of Motion and Functional Outcomes

Patients with arthritis experienced diminished range of motion and poorer patient-reported outcomes regarding general functioning and satisfaction, but no altered grip strength [5]. These measurements are related to a new classification system which, as movement and function improves, indicates the efficacy of management [20]. Pulley rupture or insufficiency is a diagnostic and therapeutic dilemma owing to the overall rarity of the injury as well as the lack of comparative clinical studies describing its diagnosis, treatment, and outcome [23]. Function should be assessed with region-specific upper extremity patient reported outcome measure, with no consensus regarding which region-specific tool [52]. Assessment of hand strength has proved to be reliable and valid as an objective parameter to evaluate the functional integrity of the hand as part of the musculoskeletal system [55]. Hand strength measurement is clinically used to determine the effectiveness of different treatment strategies in traumatic hand diseases as well as in diseases affecting hand function because of their systemic or local degenerative character [55]. In most cases baseline grip strength as a pre-injury or pre-illness muscle strength is not known [55]. Referencing the opposite hand for comparison considers both hands to have similar pre-illness grip strength, which might be misleading and possibly underestimates changing of contralateral strength during the illness period [55]. Established normative data are used clinically to compare the patients to a healthy population to decide about the return to pre-injury or pre-illness hand strength [55]. The problems in predicting the functional capacity of the hand from scores on specialized sensory and motor tests suggest that more versatile measuring instruments are required [127].

Investigations

Range of Motion Assessment

Range of motion in the distal interphalangeal joint and hand grip strength in an individual patient are of little value for predicting isolated finger flexion force [3]. To ensure accurate comparison, the measured angular motion of each individual joint should be recorded [35]. The closed curve derived from a motion analysis system and the area calculated from it are easier to interpret and can be compared in serial examinations [17]. While the motion analysis system provides useful data about actual anatomical deficits in injured fingers by recording dynamic changes in joint angles, the evaluation is time-consuming [46]. Using standard clinical instruments, torque angle curves objectively measured the quantity and quality of stiffness of immobilized, otherwise healthy, human PIP joints [166]. The area under a Gaussian curve can serve as a more meaningful functional assessment tool than a linear measurement such as total active motion because it emphasizes digital motion in the mid-ranges of digital motion [189]. Video motion capture identified three movement phases of the hand during lateral and pulp pinches, providing insight into the dynamics of hand movement and a basis for evaluating movement patterns in activities of daily living [44].

Strength Assessment

A new system that measures each finger's grip strength at one time and records the time course of grip motion can quantify a patient's symptoms easily and objectively, contributing to the evaluation of hand function [4]. Most patients with carpal tunnel syndrome do not appear to have notable weakness of thumb abduction strength [40]. For results of individual patients, the calculated Standard Error of Measurements and the Smallest Detectable Differences indicate that only relatively large changes in strength can be confidently detected with a hand-held dynamometer technique for intrinsic muscles [48]. A repeatable technique for measuring palmar thumb abduction strength has excellent nonparametric reliability, though large differences between raters and a lack of variability in the sample limit clinical utility [51]. Greater strength measurements were generated with the elbow at 90° rather than 45° on the Jamar dynamometer [177].

Correlation with Outcomes and Pathology

More advanced radiographic trapeziometacarpal osteoarthritis severity is associated with lower grip strength and poorer self-reported functional outcomes [132]. Restoration of 'normal' radiographic parameters may not be necessary to achieve a satisfactory functional outcome for the patient with distal radius fractures [145]. Better final radiological and objective physical results were associated with a better patient-perceived outcome, as measured by the DASH score, in patients with displaced distal radius fractures [159]. Dorsal intercarpal ligament capsulodesis does not consistently prevent radiographic deterioration and the development of arthrosis in the long-term; however, the level of functionality and patient satisfaction remained relatively high in 58% of patients, suggesting a lack of correlation between radiographic findings and functional outcomes [173]. Greater scapular dyskinesis is associated with lower hand grip strength [174]. Only patients with volar tilt and ulnar variance restored had a good functional outcome after distal radius fractures [188]. Most studies find no relationship between radiographic subsidence of an average of 5 millimeters and levels of strength, capability, comfort, or satisfaction after trapeziometacarpal arthroplasty [180].

Clinical Examination Context

A careful physical examination is essential to direct care and future testing if indicated, as diagnostic tests such as imaging and serum laboratory studies can be expensive, time consuming, and often nonspecific [18]. Functional capacity evaluations should not replace the surgeon's determination of a patient's abilities based on objective physical examination and radiographic findings; the best form of assessing the ability to return to work is based on a competent physician's understanding of residual impairments combined with knowledge of the patient's work requirements [22].

Treatment

Assessment and Measurement

Physical outcome measures are shifting toward patient-reported outcomes, as range of motion and strength are not as reliable measures as previously thought [1]. Functional range of motion remains critical for directing indications for surgery and rehabilitation, and for assessing treatment outcomes [2]. When evaluating the robustness of outcome measures for upper extremity function, assessments should examine structure, function, patient-reported outcomes, morbidity/mortality, and cost [63]. However, no consensus exists regarding which region-specific tool to use for assessing function with region-specific upper extremity patient-reported outcome measures [52].

Grip and Strength Measurement: Therapists must be clear about why they wish to measure a person's grip strength and consider how an accurate and useful measurement can best be obtained [147]. New features in digital dynamometers, unavailable with the analog Jamar dynamometer and unaccounted for in existing clinical guidelines, could potentially influence grip scores [9]. The majority of hands (256, or 89%) had a maximal grip strength at setting II of the dynamometer [27]. Although the effects of type of outcome score were consistent, the statistically significant effects of forearm position and outcome score may be too small (<1 lb) to be clinically relevant [60]. The effects of three trials on grip and pinch strength measurements appeared to be very minimal for normal subjects and rehabilitation patients [131]. There was no significant difference in strength between dominant and non-dominant hands [150].

Rehabilitation and Non-Operative Management

The mainstay of therapy for Complex Regional Pain Syndrome should include active and passive joint range of motion, including stress-loading activities, transcutaneous electrical nerve stimulation (TENS) desensitization techniques, or sensory reeducation or any combination of these therapies [84]. Compared with conventional rehabilitation, movement representation techniques increase pain relief, functional performance and range of motion [130]. An exercise regimen for carpometacarpal osteoarthritis was developed in accordance with American College of Sports Medicine guidelines to preserve CMC joint range of motion and increase the strength of the stabilizing muscles of the thumb [31]. Kinesiotaping alone resulted in significant improvement in symptoms and function compared to the control group in the first two months, but this improvement did not continue at the 3rd month and was not superior to other treatment groups [134]. The Relative Motion concept and orthoses have evolved from the 1980s to be widely embraced by hand therapists and surgeons worldwide for managing extensor and flexor tendon repairs, with considerable supportive evidence now available [167].

Operative Outcomes and Postoperative Protocols

Fracture Fixation and Rehabilitation: Volar locking plating enhances earlier recovery in range of motion and grip strength than intrafocal pinning for dorsally angulated, unstable distal radius fractures in elderly patients [58]. A large registry study supports the hypothesis that early active motion rehabilitation may not lead to better range of motion long-term than passive motion protocols following flexor tendon repair [13]. During the initial 28 days after a closed extra-articular metacarpal fracture, an early controlled passive motion protocol led to a clinical and statistical significant reduction in fracture dorsal angulation and improvement in the fracture's ability to resist and bear 4-point bending loads without increasing the total callus area [186].

Arthroplasty and Joint Reconstruction: The volar approach for proximal interphalangeal joint arthroplasty offers the advantages of maintaining the integrity of the extensor mechanism and allowing early postoperative motion [181]. Postoperative protocols for trapeziometacarpal arthroplasty involve a thumb cast for 3 weeks after suture removal, followed by non-resisted active range-of-motion exercises and gradually increasing strengthening exercises [158]. First ray stabilization with mini-tightrope appears to be a valuable solution to maintain good mobility in patients with low strength requirements on their daily lives [59].

Functional Considerations and Complications: The range of movement of the joint just proximal to a digital amputation was regained early, and at the end of one year the average recovery was still about 87% [32]. The use of low profile splints to limit wrist range of motion demonstrated a correlation between restricted wrist motion and functional ability [183]. The effect of blocking flexion of one finger on the other digits varied considerably between individuals, preventing the prediction of the effect of stiffness on hand strength [39]. Patients with shoulder impingement in their nondominant arm demonstrated a more global loss of range of motion compared with patients having impingement in their dominant arm [161].

Complications

Repair-site gap: A gap at the repair site exceeding three millimeters prevents the accrual of strength and stiffness that normally occurs with time [164]. However, a gap of this magnitude does not increase the prevalence of adhesions or impair the range of motion [164].

Distal radius fracture sequelae: Extra-articular malalignment following distal radius fractures is associated with pain and decreased grip strength [42]. Intra-articular gaps caused by fracture lines result in significant joint incongruity that could possibly interfere with wrist and hand function [42]. Resulting chondral lesions and increased pressure on the articular surface interfere with sagittal motion of the carpal bones, restricting the range of wrist movement [42]. Radial shortening results in loss of volar tilt, interferes with the function of the distal radioulnar joint, and can lead to midcarpal instability [42].

Posttraumatic arthritis: Patients with posttraumatic arthritis following distal radius fractures experienced diminished range of motion and poorer patient-reported outcomes regarding general functioning and satisfaction [5]. These patients did not experience altered grip strength [5].

Other Considerations: Cross-education effects on shoulder rotator muscle strength after shoulder stabilization surgery have no effect on functional outcomes [6]. Mid-frequency electrical muscle stimulation during immobilization after arthroscopic rotator cuff repair has an unclear long-term impact on functional outcomes [54]. Loss of the abductor pollicis longus and extensor pollicis brevis motor units had no functional effect upon thumb pinch-strength or hand grip [143], though it had only a minimal adverse effect upon thumb movement [143]. Thumb strength is relatively preserved with carpal tunnel syndrome, which does not preferentially impair thumb abduction strength [171]. Fifty-eight percent of patients had good hand function results following trapeziectomy with ligamentoplasty stabilisation, although the spherical grip was the most difficult to restore [165]. The range of movement of the joint just proximal to a digital amputation was regained early, with an average recovery of about 87% at the end of one year [32]. EAM rehabilitation may not lead to better range of motion long-term than passive motion protocols following flexor tendon repair [13].

Recovery

Measurement and Assessment: Accurate assessment of hand strength requires repeat testing, as a single trial or the highest score of three trials is less accurate than the mean of three trials [49, 205]. Rapid, repeated measurement of grip strength is not a reliable discriminator between true and faked hand weakness [30]. A novel finger grip dynamometer system that measures each finger's grip strength simultaneously and records the time course of grip motion can quantify patient symptoms objectively [4]. In manual muscle testing of intrinsic hand muscles, the Medical Research Council scale is modified such that grade 3 indicates "full active range of motion" rather than "movement against gravity" [29]. Manual muscle testing of the hand typically evaluates a group of muscles rather than a single muscle in isolation [29].

Range of Motion: Functional range of motion is important for directing indications for surgery and rehabilitation and for assessing treatment outcomes [2]. Age is likely to have a significant effect on postoperative range of motion and strength [14]. Early active motion rehabilitation may not lead to better long-term range of motion than passive motion protocols following flexor tendon repair [13]. The increase in passive range of motion of a stiff joint is directly proportional to the total end range time, or the length of time the joint is held at its end range [66]. Volar locking plating enhances earlier recovery in range of motion compared to intrafocal pinning for dorsally angulated, unstable distal radius fractures in elderly patients [58]. Patients with posttraumatic arthritis following distal radius fractures experienced diminished range of motion but no altered grip strength [5]. The range of movement of the joint proximal to a digital amputation is regained early, with an average recovery of approximately 87% at one year [32]. In the great majority of patients, idiopathic frozen shoulder is a self-limiting condition in which symptoms subside and full shoulder movement returns within a maximum of two years from the onset of symptoms [202, 203].

Strength: Hand grip strength has predictive potential regarding short- and long-term mortality and morbidity [28]. Normative data for grip strength across the life course have been established [201]. Bilateral handgrip strength assessments may have clinical utility in guiding rehabilitation strategies after rotator cuff repair [62]. Mid-frequency electrical muscle stimulation during immobilization may prevent early deltoid muscle atrophy and promote early strength recovery after arthroscopic rotator cuff repair, though its long-term impact on functional outcomes remains unclear [54]. Isolated gracilis tendon harvesting is not associated with loss of strength [7].

Functional Outcomes and Rehabilitation: Good functional outcome and excellent knee-specific subjective outcome were found following isolated gracilis tendon harvesting [7]. Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes [64]. An interval throwing progression should be gradual in nature and should not include maximum effort throws in the early phase of throwing [200]. Forty-seven (96%) of forty-nine shoulders had a good clinical result after distal release of deltoid muscle contracture [67]. At follow-up ranging from 8 to 18 years, 37 patients with ankle-joint injuries were clinically assessed as good, 9 as fair, and none as poor [204]. The conclusion of improved functional results with a new functional brace for Colles' fractures is not valid in the long run (13 weeks onwards), as there was no significant difference in pinch strength between brace and control groups at 13 and 26 weeks [154].

Key Evidence

• [Paper] Physical outcome measures are being changed for the use of patient reported outcomes, and range of motion and strength are not as reliable measures as one would think. [1] (10.1016/j.injury.2019.11.017)
• [L4] The functional range of motion is important for directing indications for surgery and rehabilitation, and assessing outcome of treatment. [2] (10.1177/1753193414533754)
• [L4] Range of motion in the distal interphalangeal joint and hand grip strength in the individual patient are of little value for prediction of isolated finger flexion force. [3] (10.1016/s0363-5023(82)80016-6)
• [L4] This new system that measures each finger's grip strength at one time and records the time course of grip motion could quantify a patient's symptoms easily and objectively, which may contribute to the evaluation of hand function. [4] (10.1186/s13018-020-01773-9)
• [L3] Patients with arthritis experienced diminished range of motion and poorer patient-reported outcomes regarding general functioning and satisfaction, but no altered grip strength. [5] (10.1007/s00402-018-3046-2)
• [L1] However, it has no effect on functional outcomes. [6] (10.1016/j.jse.2023.10.037)
• [L3] Additionally, good functional outcome as well as excellent knee-specific subjective outcome was found. [7] (10.1007/s00167-019-05790-y)
• [L4] It can assess the strength of various muscle groups following disease or surgery, determine the effectiveness of therapy, and detect old muscle injuries that have escaped detection by existing methods of diagnosis. [8] (10.2106/00004623-196345010-00011)
• [L3] These findings suggest the need to consider how new features, unavailable with the analog Jamar dynamometer and unaccounted for in existing clinical guidelines, could potentially influence grip scores. [9] (10.1016/j.jht.2011.01.004)
• [L4] [10] (10.1197/j.jht.2007.04.005)
• [Paper] This paper discusses a method of controlled torque and joint position that has been used experimentally and clinically as a tool for objective assessment of passive range of motion. [11] (10.1016/s0894-1130(12)80363-2)
• [L4] This large registry study supports the hypothesis that EAM rehabilitation may not lead to better range of motion long-term than passive motion protocols. [13] (10.1016/j.jhsa.2024.08.003)
• [L4] Age will most likely have a significant effect on postoperative ROM and strength. [14] (10.1016/j.jseint.2022.08.016)
• [L4] The findings of this study suggest that the Latarjet procedure more commonly affects range of motion rather than shoulder and elbow strength. [15] (10.1177/17585732231165227)
• [Paper] Consequently, patients using low-profile outriggers require more strength to initiate and maintain active movement opposite to the mobilizing force, even when dynamic-assist forces are equal. [16] (10.1016/s0894-1130(96)80021-4)
• [L4] The closed curve derived from the motion analysis system and the area calculated from it were easier to interpret and could be compared in serial examinations. [17] (10.1016/s0266-7681(96)80139-2)
• [L5] These measurements are related to a new classification system which, as movement and function improves, indicates the efficacy of management. [20] (10.1016/j.jhsb.2004.02.007)
• [L4] Decreased grip strength in a patient with “obscure” wrist pain is a reliable indicator of a pathologic process that deserves further investigation. [21] (10.1016/0363-5023(88)90191-8)
• [L5] Functional capacity evaluations should not replace the surgeon's determination of a patient's abilities based on objective physical examination and radiographic findings; the best form of assessing the ability to return to work is based on a competent physician's understanding of residual impairments combined with knowledge of the patient's work requirements. [22] (10.1016/j.jhsa.2015.11.008)
• [L5] Pulley rupture or insufficiency is a diagnostic and therapeutic dilemma owing to the overall rarity of the injury as well as the lack of comparative clinical studies describing its diagnosis, treatment, and outcome. [23] (10.1016/j.jhsa.2012.07.021)
• [L5] Ideally, digits need sensation and freedom of motion to enable patients to use them effectively, and effective surgery restores biomechanical motions so patients have optimum use. [24] (10.1016/j.hcl.2013.08.003)
• [Paper] There is no substitute for manual testing for muscle length, and hand-held devices are not justified for grading strength except in a few instances. [25] (10.1016/s0894-1130(12)80088-3)
• [L5] Improved understanding of this motion pattern may lead to changes in functional rehabilitation following injury and in surgical management. [26] (10.5435/00124635-201001000-00007)
• [L4] The majority of hands (256, or 89%) had a maximal grip strength at setting II. [27] (10.1016/s0363-5023(96)80351-0)
• [L4] Numerous clinical and epidemiological studies have shown the predictive potential of hand grip strength regarding short and long-term mortality and morbidity. [28] (10.1016/j.clnu.2010.09.010)
• [Paper] [29] (10.1197/j.jht.2006.07.024)
• [L3] Rapid, repeated measurement of grip strength is not a reliable discriminator of true and faked hand weakness. [30] (10.1054/jhsb.2000.0433)
• [L4] The exercise regimen was developed in accordance with recommendations of the American College of Sports Medicine guidelines for the development of individualized exercise prescriptions to preserve CMC joint range of motion and increase the strength of the stabilizing muscles of the thumb. [31] (10.1016/j.jht.2012.03.008)
• [L3] The range of movement of the joint just proximal to the amputation was regained early, and at the end of one year the average recovery was still about 87%. [32] (10.1016/0266-7681(93)90211-w)
• [L4] The study aimed to identify the specific amount of motion allowed within four different immobilization devices and the level of function allowed within each device to establish data for evidence-based decisions. [33] (10.1016/j.jht.2009.07.011)
• [L4] Successful replantation for a radiocarpal joint amputation is associated with major restriction of motion, decreased strength, and moderate disability on functional outcome assessments. [34] (10.1016/j.jhsa.2014.10.017)
• [L5] The measured angular motion of each individual joint also should be recorded for a more accurate comparison. [35] (10.1016/s0363-5023(80)80050-5)
• [L4] More study of anatomical morphological patterns may explain the reason for variations in motion and grip- strength. [36] (10.1142/s2424835516500351)
• [L4] The effect of blocking flexion of one finger on the other digits varied considerably between individuals, preventing the prediction of the effect of stiffness on hand strength. [39] (10.1016/j.jhsb.2006.11.005)
• [L3] Most patients with CTS do not appear to have notable weakness of thumb abduction strength. [40] (10.1016/j.jhsa.2007.04.007)
• [L3] The measurement of extension grip strength is a useful objective tool to aid in the diagnosis of lateral epicondylitis. [41] (10.1016/j.jhsa.2007.04.010)
• [L3] [42] (10.1177/1758998315574352)
• [L4] Our findings support that we have presented a tool which can be used in future study within this population to better understand the hand kinetics associated with the highly problematic task of jar-opening and joint protection strategies intended to reduce hand loads. [43] (10.1016/j.jht.2021.04.012)
• [L4] The results provide new insight to the dynamics of hand movement as well as a basis for subsequent evaluations of movement patterns performed in ADLs and instrumental ADLs. [44] (10.1007/s11552-013-9517-6)
• [L4] The motion analysis system provides useful data about actual anatomical deficits in injured fingers by recording dynamic changes in joint angles, though the evaluation is time-consuming. [46] (10.1054/jhsb.1999.0344)
• [L4] We have developed a system for measuring hand strength which is accurate and reliable, but easy and quick to operate. [47] (10.1016/s0266-7681(85)80052-8)
• [L3] However, for the results of individual patients, the calculated Standard Error of Measurements and the Smallest Detectable Differences indicate that only relatively large changes in strength can be confidently detected with this technique. [48] (10.1054/jhsb.2000.0415)
• [L4] Repeat testing appears essential for an accurate assessment of an individual's strength. [49] (10.1016/0363-5023(89)90071-3)
• [L4] Measurement of thumb abduction strength may prove to be a useful adjunct to the various tests currently used by hand surgeons to assess hand function. [50] (10.1016/s0363-5023(97)80079-2)
• [L5] The study validates a repeatable technique for measuring palmar thumb abduction strength with excellent nonparametric reliability, though large differences between raters and a lack of variability in the sample limit clinical utility and require further study with a larger, more diverse population. [51] (10.1016/j.jht.2018.09.010)
• [L5] [52] (10.1016/j.jht.2023.08.008)
• [L5] Not all muscles in the hand can be sufficiently isolated to grade their strength, nor is it always necessary to test all muscles innervated by a particular nerve to evaluate the presence or extent of motor function impairment or monitor changes. [53] (10.1016/s0894-1130(01)80005-3)
• [L3] However, its long-term impact on functional outcomes remains unclear and warrants further investigation. [54] (10.1002/ksa.70303)
• [L4] [55] (10.1177/1753193408099829)
• [L2] VLP enhances earlier recovery in range of motion and grip strength than IFP. [58] (10.1016/j.jhsa.2007.07.005)
• [L4] It appears to be a valuable solution, in order to maintain good mobility in patients with low strength requirements on their daily lives. [59] (10.1177/1558944716660555l)
• [L4] Although the effects of type of outcome score were consistent, the statistically significant effects of forearm position and outcome score may be too small (<1 lb) to be clinically relevant. [60] (10.1197/s0894-1130(03)00159-5)
• [L5] Achieving a functional and durable outcome requires proper patient selection, careful preoperative planning, and accurate implantation. [61] (10.1097/01.bth.0000131199.39073.2a)
• [L2] These findings highlight the potential clinical utility of bilateral handgrip strength assessments in guiding rehabilitation strategies after rotator cuff repair. [62] (10.1016/j.jse.2025.07.010)
• [L5] [63] (10.1016/j.jhsa.2018.10.006)
• [L2] Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes. [64] (10.1016/j.jhsa.2014.01.012)
• [L4] No differences were observed among the LBP subgroups, and further studies with appropriate diagnostic procedures are needed to elucidate if different types of LBP are related to altered biomechanics, physiology, and function. [65] (10.3390/life11030226)
• [L2] The increase in passive range of motion of a stiff joint is directly proportional to the length of time the joint is held at its end range, or total end range time (TERT). [66] (10.1016/j.jht.2011.12.003)
• [L3] Forty-seven (96 per cent) of the forty-nine shoulders had a good clinical result after distal release of the contracture. [67] (10.2106/00004623-199802000-00010)
• [L2] Limited joint mobility of the thumb and index finger may cause temporal changes in precision grip force control, which can lead to reduced manual dexterity. [88] (10.1016/j.jht.2013.05.007)
• [L3] Standard manual strength-testing of the intrinsic muscles of the hand was not diagnostically sensitive. [94] (10.2106/00004623-199703000-00013)
• [L3] Individuals with hand OA modulate grip force magnitude and temporal parameters but apply higher grip forces at liftoff and peak, and demonstrate longer latency compared to controls. [95] (10.1016/j.jht.2011.06.002)
• [L4] Grip-load force adjustments are not completely determined by the mechanics of object motion; nonmechanical factors related to movement performance, for instance perceptual factors, may affect the coupling. [97] (10.1197/j.jht.2007.06.002)
• [L4] The dynamic interaction of finger joints during cylinder grip shows specific patterns, with DIP joints consistently initiating flexion last and synchronization increasing significantly by the end of motion compared to the beginning. [98] (10.1177/1753193412444399)
• [L4] The middle finger was the most important contributor to grip strength. [101] (10.1016/j.jhsa.2014.06.121)
• [L4] Providers can use the strongest grip strength values obtained in clinical practice to compare with reported dominant hand grip strength values. [105] (10.1016/j.jht.2024.08.027)
• [L5] At increasing amounts of finger flexion, progressive metacarpal shortening produces proportionally greater loss of fingertip flexion force. [106] (10.1177/1753193412461589)
• [L4] [107] (10.1016/s0894-1130(99)80048-9)
• [L3] Those subjects demonstrate a significant decrease in maximum velocity in slow fist tasks, highlighting the need for comprehensive assessment to ascertain the full extent of functional limitations that can occur in the setting of hand pathology. [108] (10.1177/1558944717729218)
• [L3] For use as a diagnostic tool, standardization and device-specific cutoff points for handgrip dynamometry are needed. [110] (10.1371/journal.pone.0270132)
• [L4] At a position of 30 of wrist extension, maximal grip strength is achieved without significantly compromising grip endurance. [111] (10.1016/j.jhsa.2016.07.100)
• [L4] Multifinger performance was not predictable from single-finger strengths, and the information derived may be helpful to clinically identify and isolate muscle pathology. [115] (10.1197/j.jht.2008.02.002)
• [L5] Simultaneous activation of the FDP and the intrinsic muscles results in an apparently more functional hand closing compared with FDP activation alone because of altered kinematics and larger fingertip-to-palm distances. [117] (10.1016/j.jhsa.2013.08.099)
• [L4] The test-retest reliability of grip strength measurement in full elbow extension in healthy participants is excellent, demonstrating its potential for use in clinical practice. [118] (10.1177/1753193412449804)
• [L4] Although this disease affects abductor and extensor tendons, strength and ROM of the thumbs were found to be decreased in all directions tested. [123] (10.1197/j.jht.2006.07.008)
• [L3] Since assessments using range-of-motion measurements or a questionnaire are not sufficient to evaluate a patient's movement disorder, a kinematic analysis should be conducted for quantitative assessments. [125] (10.1177/1558944720949952)
• [L4] Affected hands demonstrated diminished results with FDT, and pinch strength when compared with previously published ranges for normals. [126] (10.1197/j.jht.2003.10.034)
• [L5] [127] (10.1016/0363-5023(89)90010-5)
• [L5] Unless handheld dynamometry is widely adopted or a better grading system is developed and well validated, the MRC will continue to be used. [129] (10.1016/j.jhsa.2006.11.008)
• [L1] Compared with conventional rehabilitation, movement representation techniques increase pain relief, functional performance and range of motion. [130] (10.1186/s12891-025-08496-0)
• [L4] The effects of three trials on grip and pinch strength measurements appeared to be very minimal for normal subjects and rehabilitation patients. [131] (10.1016/s0894-1130(12)80377-2)
• [L3] More advanced radiographic trapeziometacarpal OA severity is associated with lower grip strength and poorer self-reported functional outcomes. [132] (10.1016/j.jht.2021.10.001)
• [L2] Kinesiotaping alone resulted in significant improvement in symptoms and function compared to the control group in the first two months, but this improvement did not continue at the 3rd month and was not superior to other treatment groups. [134] (10.5152/tftrd.2014.24993)
• [L2] From all analyzed motions, the highest FFM was found in external rotation in all groups. [135] (10.1016/j.asmr.2025.101288)
• [L4] Strength of the thumb is affected in all types of triphalangeal thumb, although it is apparently sufficient in daily life for the investigated group. [139] (10.1177/1753193412438195)
• [L5] Evidence-based administration and interpretation of grip strength assessment by rehabilitation professionals are essential components of comprehensive assessment across the continuum of care. [140] (10.1177/1558944716660555kr)
• [Paper] The term "Stiffness" of a structure always requires an exact description of the load configuration and the exact localization and kind of deformation measured. [141] (10.1016/s0020-1383(00)80040-6)
• [L4] Patients were able to return to regular activities with excellent range of motion and restored lifting capacity, reporting no pain and utmost satisfaction with the prosthesis. [142] (10.1016/j.hcl.2012.08.023)
• [L4] Loss of the abductor pollicis longus and extensor pollicis brevis motor units had no functional effect upon thumb pinch-strength or hand grip, and only a minimal adverse effect upon thumb movement. [143] (10.1054/jhsb.2001.0744)
• [L2] Restoration of 'normal' radiographic parameters may not be necessary to achieve a satisfactory functional outcome for the patient. [145] (10.1302/0301-620x.99b3.35819)
• [L4] This study emphasizes the need for standardized procedures when testing torque strength. [146] (10.1016/s0894-1130(87)80008-x)
• [L5] Therapists need to be clear about why they wish to measure a person's grip strength and consider how an accurate and useful measurement can best be obtained. [147] (10.1177/175899830501000101)
• [L4] The results indicate that the motion analysis system is a reliable tool for the evaluation of fingertip motion. [149] (10.1016/s0266-7681(98)80219-2)
• [L4] There was no significant difference in strength between dominant and non-dominant hands. [150] (10.1016/0266-7681(93)90212-x)
• [L4] In the fingers, only a small percentage of the active range of motion of the joints was required for functional tasks. [152] (10.1016/0363-5023(90)90102-w)
• [L5] The author argues that the conclusion of improved functional results with the brace is not valid in the long run (13 weeks onwards), as Table VII shows no significant difference in pinch strength between brace and control groups at 13 and 26 weeks. [154] (10.1016/s0020-1383(97)83189-0)
• [L4] [155] (10.1177/1753193413518709)
• [L3] [158] (10.1016/j.jhsa.2009.04.016)
• [L3] Better final radiological and objective physical results were associated with a better patient-perceived outcome, as measured by the DASH score, in this patient group. [159] (10.1197/j.jht.2007.06.001)
• [L3] Patients with shoulder impingement in their nondominant arm demonstrated a more global loss of range of motion compared with patients having impingement in their dominant arm. [161] (10.1177/036354650002800501)
• [L5] A gap at the repair site of more than three millimeters does not increase the prevalence of adhesions or impair the range of motion but does prevent the accrual of strength and stiffness that normally occurs with time. [164] (10.2106/00004623-199907000-00010)
• [L4] Fifty-eight percent of patients had good hand function results, with the spherical grip being the most difficult to restore. [165] (10.1016/j.otsr.2009.03.015)
• [L4] Using standard clinical instruments, torque angle curves objectively measured the quantity and quality of stiffness of immobilized, otherwise healthy, human PIP joints. [166] (10.1016/s0894-1130(88)80050-4)
• [L5] The Relative Motion concept and orthoses have evolved from the 1980s to be widely embraced by hand therapists and surgeons worldwide for managing extensor and flexor tendon repairs, with considerable supportive evidence now available. [167] (10.1016/j.jht.2023.03.006)
• [L4] [169] (10.1177/175899830400900101)
• [L1] [170] (10.1016/0020-1383(95)00111-l)
• [L3] Thumb strength is relatively preserved with carpal tunnel syndrome, and the study failed to support the traditional belief that carpal tunnel syndrome preferentially impairs thumb abduction strength. [171] (10.1097/01.blo.0000181143.93681.0d)
• [L4] The DILC does not consistently prevent radiographic deterioration and the development of arthrosis in the long-term; however, the level of functionality and patient satisfaction remained relatively high in 58% of our patients, suggesting a lack of correlation between the radiographic findings and development of arthrosis and the functional outcomes and patient satisfaction. [173] (10.1016/j.jhsa.2007.07.016)
• [L4] This suggests greater the scapular dyskinesis, lower will be the hand grip strength. [174] (10.1177/17585732241309088)
• [L4] Greater strength measurements were generated with the elbow at 90° rather than 45° on the Jamar. [177] (10.1016/s0363-5023(05)80029-2)
• [L1] The observation that most studies find no relationship between radiographic subsidence of an average of 5 millimeters and levels of strength, capability, comfort, or satisfaction after TMC arthroplasty suggests that primary surgeries may not benefit from a focus on limiting subsidence and revision arthroplasty ought not be offered based on this radiographic measure. [180] (10.5435/jaaos-d-23-01264)
• [L4] The volar approach offers the advantages of maintaining the integrity of the extensor mechanism and allowing early postoperative motion. [181] (10.1016/j.jhsa.2011.03.003)
• [L3] The use of low profile splints to limit wrist range of motion did demonstrate a correlation between restricted wrist motion and functional ability. [183] (10.1016/j.jht.2009.07.002)
• [L4] [185] (10.2106/00004623-197961040-00010)
• [L5] During the initial 28 days after the fracture, the early controlled passive motion protocol led to a clinical and statistical significant reduction in fracture dorsal angulation and improvement in the fracture's ability to resist and bear 4-point bending loads without increasing the total callus area. [186] (10.1016/j.jhsa.2006.11.004)
• [L4] Only patients with volar tilt and ulnar variance restored had a good functional outcome. [188] (10.1016/j.injury.2014.10.018)
• [L4] The area under the Gaussian curve can serve as a more meaningful functional assessment tool than a linear measurement such as total active motion, because it emphasizes digital motion in the mid-ranges of digital motion. [189] (10.1053/jhsu.2001.21512)
• [L4] [192] (10.1016/j.injury.2009.08.024)
• [L4] [193] (10.1016/j.jht.2014.08.003)
• [L5] The interval throwing progression should be gradual in nature and not include maximum effort throws in the early phase of throwing. [200] (10.1177/0363546514536693)
• [L3] This is the first study to provide normative data for grip strength across the life course. [201] (10.1371/journal.pone.0113637)
• [L4] In the great majority of patients idiopathic frozen shoulder is a self-limiting condition, in which symptoms subside and full shoulder movement returns within a maximum of two years from the onset of symptoms. [202] (10.2106/00004623-197860040-00030)
• [L4] In the great majority of patients idiopathic frozen shoulder is a self-limiting condition, in which symptoms subside and full shoulder movement returns within a maximum of two years from the onset of symptoms. [203] (10.2106/00004623-197860040-00029)
• [L4] At follow-up ranging from 8 to 18 years, 37 patients were clinically assessed as good, 9 as fair, and none as poor. [204] (10.1016/s0020-1383(69)80036-7)
• [L4] The mean of three trials is a more accurate measure of hand strength than one trial or the highest score of three trials. [205] (10.1016/s0363-5023(84)80146-x)

See Also

• Flexor tendon repair
• Dislocations
• Trapeziectomy

References

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